Healthcare Provider Details

I. General information

NPI: 1043683980
Provider Name (Legal Business Name): STEPHANIE MASSEY LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2015
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 MARIAN LN
VIRGINIA BEACH VA
23462-1841
US

IV. Provider business mailing address

1830 N WASHINGTON AVE APT A
CLEARWATER FL
33755-1839
US

V. Phone/Fax

Practice location:
  • Phone: 757-456-5018
  • Fax:
Mailing address:
  • Phone: 843-250-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA33228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: